Provider Demographics
NPI:1659362689
Name:CRONAUER, STACEY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:CRONAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SPRING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICA
Mailing Address - State:DE
Mailing Address - Zip Code:19946-1886
Mailing Address - Country:US
Mailing Address - Phone:302-335-3552
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL ALTERNATIVE CARE INC.
Practice Address - Street 2:1275 S STATE ST.
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-678-1303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP11990Medicare UPIN
DE008970M20Medicare ID - Type Unspecified